| Purpose:At present,brace wearing has been proven to be the most effective non-surgical treatment for the prevention of bending progression in Adolescent Idiopathic Scoliosis(AIS)patients,but 28% of patients are still at risk of correction failure.Current radiographic assessments of the patient’s entire spine are derived from standing radiographs.However,little is known about the variability of threedimensional parameters of the spine over 8 hours per day in the seated position in school-aged adolescents wearing braces.The three-dimensional parameters within the braces determine the effectiveness of brace correction.It is not known whether the brace differs due to the change in position.Therefore,this study aims to observe whether the three-dimensional parameters of the spine of patients with Rigo A type AIS are variable when they wear braces in stand and sit,in order to provide more accurate data for the preparation and adjustment of braces,so as to achieve more ideal correction effect.Methods:A self-controlled study was conducted to observe the characteristics of some parameters at the three-dimensional level of the spine in radiological standing and sitting position of Rigo A type AIS patients wearing braces.A total of 40 AIS patients who were treated at Guangdong Scoliosis Exercise Rehabilitation and Orthosis Engineering Technology Research Center and had not received other types of brace treatment before presentation were included(Mean age 13 years,mean Cobb Angle 35.71 ± 4.82 °,7 males and 33 females.)Full-spine anteroposterior and lateral radiographs were taken by a trained and experienced radiologist using wholespine EOS? Images(EOS)at the first visit and wearing a brace.Each patient’s spinal X-ray image was then 3D modeled though using Ster EOS(Version:1.6,EOS Imaging,Paris,France)software.After obtaining the 3D model,the following parameters were measured: Coronal Cobb Angle,coronal pelvic inclination(PO),Clavicle Angle(CA);Sagittal plane parameters: thoracic kyphosis(TK),Thoracic kyphosis angles TK(T1/T12)and TK(T4/T12),lumbar lordosis angles LL(L1/L5)and LL(L1/S1).Thoracolumbar joint Angle fluctuation olumbar kyphosis(TLJ);sacral slope(SS),Pelvic incidence(PI),Pelvic tilt(PT),sagittal vertical axis(SVA);Thoracic Inlet Angle(TIA),cervical curvature of C2-7(C2-7Cobb),T1slope(T1S).Axial plane parameters: apical rotation(AVR),Upper vertebral rotation(Upper IAR)and Lower vertebral rotation(Lower IAR),overall torsion coefficient(TI).SPSS26.0 software was used to analyze and evaluate the imaging differences of the above threedimensional parameters in the sitting and standing positions during the first diagnosis and the wearing of the brace.If there was differences in standing and sitting positions position when wearing braces in the same dimension,Pearson bivariate correlation analysis was further used to compare the correlation between parameters.Result:1.Basic information: the average age of 40 Rigo A AIS patients was13.59±3.2 years old,and the average Cobb Angle of the main bend was 35.71±4.82°;Average height: 162.5± 6.8cm;The average body weight was 53.3±6.9kg;The average BMI index was 20.3±2.8kg/m 2.Risser sign 0-3;The brace correction rate was more than 50%.2.Changes of coronal plane parameters: there were no significant difference in Cobb Angle,PO,CA and SO of coronal plane parameters between standing and sitting position at the first visit and after bracing.The Cobb Angle was significantly improved in the standing position after wearing braces compared with the first visit.The Cobb Angle was significantly decreased in the sitting position after wearing braces compared with the sitting position at the first visit.(all P<0.05).3.Changes of sagittal plane parameters:(1)At the patients’ first visit,sagittal plane parameters such as TK(T1/T12)TK(T4/T12),LL(L1/L5),LL(L1/S1),SS decreased,PT increased and SVA shifted forward when transitioning from the standing position to the sitting position(P<0.05).(2)After wearing braces,the standing position of TK(T4/T12),LL(L1/L5)and LL(L1/S1)were significantly decrease compared with the standing position at the first visit(P<0.05),TLJ increased significantly(P<0.05).(3)After wearing braces,the sitting position of TK(T4/T12),LL(L1/L5),LL(L1/S1),SS,C2-7Cobb angles were significantly decreased compared with the sitting position at the first visit(P<0.05),PT and TLJ were significantly increased(P< 0.05).(4)Compared with standing position,sitting position with braces decreased significantly in TK(T1/T12)and TK(T4/T12),LL(L1/L5)and LL(L1/S1),SS(P<0.05),PT and TLJ significantly increased(P<0.05),and SVA significantly shifted forward(P < 0.05).4.Comparison of axial parameters: There was no significant difference in axial parameters between sitting and standing positions at both the first visit and after braces,(P>0.05).AVR and TI decreased significantly when wearing brace compared with the first visit in standing position(P<0.05).AVR and TI decreased significantly when wearing brace compared with the first visit in sitting position(P<0.05).5.Rigo A-type AIS patients wearing braces in sitting position showed that: C2-7Cobb was moderately positively correlated with TK(T4/T12)(r = 0.52,P<0.05),a low positively correlated with LL(L1/L5)and SS(r = 0.38,0.36,P<0.05),and low negatively correlated with TLJ(r =-0.38,P<0.05).It has no obvious correlation with other parameters.There was a low positive correlation between C2-7Cobb and TK(T4/T12)in Rigo A type AIS patients wearing braces in standing position(r = 0.33,P<0.05).Conclusion:(1)The coronal and axial plane parameters of the spine in Rigo A type AIS patients in the sitting position showed no significant difference compared with the standing position when wearing braces.(2)Correlation analysis between C2-7Cobb and other sagittal parameters in sitting position of Rigo A type AIS patients wearing braces showed that C2-7Cobb was positively correlated with TK(T4/T12),LL(L1/L5),SS,and negatively correlated with TLJ.That is,the cervical curvature decreases with the curvature of the thoracic vertebrae and lumbar vertebrae and sacral tilt(SS)when wearing the brace in the sitting position.(3)Wearing brace can significantly affect the spinal sagittal plane parameters of Rigo A type AIS patients in the sitting position,which is mainly manifested as a decrease in the physiological curvature of the sagittal plane,suggesting that the influencing factors of body position should be considered when making and fitting the brace. |
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